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09.06.2023 | Original Article

Prognostic Factors in Patients with Unruptured Vertebral and Basilar Fusiform Aneurysms Treated with Endovascular Procedures

A Single Center Retrospective Analysis

verfasst von: Hidetoshi Matsukawa, Kazutaka Uchida, Manabu Shirakawa, Norito Kinjo, Yoji Kuramoto, Fumihiro Sakakibara, Seigo Shindo, Kiyofumi Yamada, Shinichi Yoshimura

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2023

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Abstract

Purpose

Large vertebral and basilar fusiform aneurysms (VFA) are sometimes difficult to cure by endovascular treatment (EVT). We aimed to elucidate indicators of poor outcomes of EVT in patients with VFAs.

Methods

Clinical data from 48 patients with 48 unruptured VFAs in the Hyogo Medical University were retrospectively analyzed. The primary outcome was defined as satisfactory aneurysm occlusion (SAO) according to Raymond-Roy grading scale. The secondary and safety outcomes were a modified Rankin scale (mRS) score of 0–2 at 90 days, retreatment, major stroke, and aneurysm-related death after EVT.

Results

The EVT included stent-assisted coiling (n = 24; 50%), flow diverter (n = 19; 40%), and parent artery occlusion (n = 5; 10%). The SAO was less frequently observed in large or thrombosed VFAs at 12 months (64%, p = 0.021 and 62%, p = 0.014, respectively), especially when the aneurysms were both large and thrombosed (50%, p = 0.0030). Retreatment was more common in large aneurysms (29%, p = 0.034), thrombosed (32%, p = 0.011), and large thrombosed aneurysms (38%, p = 0.0036). Although the proportion of mRS 0–2 at 90 days and major stroke showed no significant differences, that of post-treatment rupture was significantly larger in large thrombosed VFAs (19%, p = 0.032). Aneurysm-related death occurred by aneurysm rupture and was more frequent in large thrombosed VFA (19%, p = 0.032). Multivariate analysis showed SAO at 12 months was less common (adjusted odds ratio, OR: 0.036, 95% confidence interval, CI 0.00091–0.57; p = 0.018), and retreatment was more common (adjusted OR 43, 95% CI 4.0–1381; p = 0.0012) in large thrombosed VFA.

Conclusion

The large thrombosed VFAs were associated with poor outcomes after EVT including flow diverter.

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Titel: Prognostic Factors in Patients with Unruptured Vertebral and Basilar Fusiform Aneurysms Treated with Endovascular Procedures
A Single Center Retrospective Analysis
verfasst von: Hidetoshi Matsukawa
Kazutaka Uchida
Manabu Shirakawa
Norito Kinjo
Yoji Kuramoto
Fumihiro Sakakibara
Seigo Shindo
Kiyofumi Yamada
Shinichi Yoshimura
Publikationsdatum: 09.06.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 4/2023
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-023-01305-y

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Prognostic Factors in Patients with Unruptured Vertebral and Basilar Fusiform Aneurysms Treated with Endovascular Procedures

A Single Center Retrospective Analysis